Will the New Kidney Allocation System Negatively Impact Future Organ Donation in States Mandated to Export a Large Number of Kidneys?
1Kidney Transplant Program, General Surgery, Advocate Christ Medical Center, Oak Lawn, IL
2Quality and Process Improvement, Gift of Hope OPO, Itasca, IL.
Meeting: 2016 American Transplant Congress
Abstract number: C79
Keywords: Cadaveric organs, Ethics, Kidney transplantation, Waiting lists
Session Information
Session Name: Poster Session C: Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Purpose: To examine the potentially deleterious effects of the new Kidney Allocation System (KAS) on future organ donation: as a consequence of the massive increase in mandatory net export of deceased donor kidneys from Illinois.
Methods: We evaluated the net export of low KDPI (Kidney Donor Profile Index) kidneys from Illinois after a year of implementation of the new KAS by the United Network of Organ Sharing (UNOS). This was compared to the previous 4 years of historic data, including 0ABDR imports and exports. The data was collected until Nov. 30th, 2015 and annualized.
Results: There has been a >100% increase in net export of low KDPI kidneys from Illinois a year after the new KAS was implemented. There was no significant difference in the KDPI of exported kidneys (39-53), as compared to imported kidneys (45-55). This was associated with a significant decline in the number of local kidney transplants, despite an increase in the number of local donors.
| Year | Local Donors | Local Transplants | Export Kidneys | 0ABDR Exports | 0ABDR Imports | Import Kidneys | Net Exports |
| 2011 | 247 | 358 | 42 | 25 | 21 | 81 | -39 |
| 2012 | 246 | 344 | 50 | 25 | 12 | 42 | 8 |
| 2013 | 267 | 379 | 52 | 22 | 21 | 54 | -2 |
| 2014 | 291 | 377 | 93 | 34 | 12 | 37 | 56 |
| 2015 | 318 | 291 | 150 | 9 | 3 | 23 | 128 |
Conclusions: The state of Illinois is now a major exporter of good quality (low KDPI) deceased donor kidneys due to the new KAS. This may lead to hesitation in local organ donors; when they see the number of transplants has declined, despite the increase in organ donation in Illinois. With the national shortage of donor kidneys, it would be catastrophic to see a decline in deceased donation: as a result of the unintended consequences of forcing states to export kidneys.
The KAS trend update for months 7-10 (June-Sep 2015) analyzed by OPTN showed that 31% of kidneys were being shipped away from the recovering region. This was associated with an increase in cold ischemia times and delayed graft function. Long term outcomes need to be analyzed to ensure optimal utility of scarce organs. Is the new KAS the most equitable allocation system, or should we somehow limit the net export of kidneys from each region? The old UNOS method of paybacks for each kidney between regions may help to divide these organs more equitably.
CITATION INFORMATION: Mital D, Hull E, Brown J, Karmell C, Jendrisak M. Will the New Kidney Allocation System Negatively Impact Future Organ Donation in States Mandated to Export a Large Number of Kidneys? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Mital D, Hull E, Brown J, Karmell C, Jendrisak M. Will the New Kidney Allocation System Negatively Impact Future Organ Donation in States Mandated to Export a Large Number of Kidneys? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/will-the-new-kidney-allocation-system-negatively-impact-future-organ-donation-in-states-mandated-to-export-a-large-number-of-kidneys/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress